A living well lets you determine the type of care you receive - even if you're unable to speak for yourself.
Specifying what interventions you or your parents do or don’t want taken at the end of life can give you peace of mind.
What would happen if your 90-year-old parent were in the hospital and their heart stopped? Would you know if they would want CPR? If you thought they wouldn’t want CPR, how comfortable would you be telling the doctor to let your parent die?
It’s a scenario no one wants to face – and it’s the rationale behind a living will.
A living will puts your parent’s wishes in writing, instructing doctors to care for them in the manner they are most comfortable with. Just as a traditional will spells out what should be done with a person’s assets, a living will provides instructions on how they should be medically treated if they are unable to make healthcare decisions.
A living will is often used to specify a person’s wishes about life-prolonging procedures and other end-of-life care. It may include your parent’s religious or spiritual beliefs and specific measures the medical team should, or should not, follow in various circumstances. It may include guidance on religious objections to treatments, resuscitation measures, choices regarding medications, and organ and tissue donation.
What a living will covers
The kinds of decisions that a living will typically addresses are the use of the following:
CPR restores a heartbeat if a person’s heart stops or develops a dangerous rhythm. The practice involves pushing forcefully on the chest -– so forcefully it sometimes breaks the patient’s ribs. Electric shocks may be administered to restart the heart.
Ventilators or tracheotomy
If someone isn’t breathing properly, they may need a ventilator, which pushes air into the lungs. Inserting the tube down the throat, called intubation, can be very painful, but sedation can ease discomfort. People who must be on a ventilator long-term sometimes have a tube inserted directly into the trachea.
Pacemakers and defibrillators
Pacemakers and implanted defibrillators can help the heart maintain a normal rhythm and prolong a person’s life. But when a patient has a terminal illness like cancer, these devices might get in the way of a natural death and prolong suffering. A living will may address what happens if a doctor suggests it is time to turn off such a device.
Artificial nutrition and hydration
A feeding tube may be needed to sustain a person who is unable to drink or eat. Tubes may need to be surgically inserted into the stomach for long-term nutritional needs. While helpful when recovering from an illness, artificial nutrition and hydration administered toward the end of life may not significantly prolong life – or may prolong it after quality of life is gone.
Living wills vs. healthcare proxies
Sometimes a living will is confused with a healthcare proxy, which grants a specific individual the legal authority to make decisions for your parent if they are not able to make them on their own. Most states allow individuals appointed as healthcare proxies to step in when the person becomes incapacitated, not just in end-of-life situations.
Both documents can play an important role in your parent’s estate planning. In both cases, the document must be created before your parent is incapacitated and unable to make decisions.
A key difference between the two is that, unlike a healthcare proxy, a living will doesn’t grant medical decision-making power to a third party. Instead, the living will records your parent’s medical decisions in advance of an actual healthcare crisis.
One way to think about it is that living wills are good for handling clear-cut circumstances, while a healthcare proxy is best for decisions that require a judgment call. In fact, the two documents are most effective when combined.
Keep in mind that a person’s healthcare proxy cannot trump their living will. As a legally binding document, the living will cannot be overridden.
Why a living will can be a good idea
According to a 2020 poll, fewer than half of Americans have completed an advance directive, a term that includes living wills and healthcare proxies. Some fear that a doctor will decide to pull the plug on life-supporting devices, such as ventilators, prematurely.
"Many people don't sign advance directives because they worry they're not going to get any care if they say they don't want [CPR]," Katherine Courtright, MD, an instructor of medicine in pulmonary and critical care at the University of Pennsylvania, told NPR. “It becomes this very scary document that says, ‘Let me die.’”
But not having one can be distressing and even traumatic. If a parent doesn’t have one and becomes incapacitated, healthcare providers and family members would have to guess what medical care a patient would want to receive.
“If the patient hasn’t articulated a clear preference, it’s very, very hard for doctors and families to work together to make the decision,” Douglas White, MD, an associate professor of critical care medicine and director of the program on ethics and decision-making in critical illness at the University of Pittsburgh, told NBC News. “(They’re) left to do the best that they can that generally reflects who the patient is as a person.”
Individuals may wish to have a living will in order to protect their loved ones from the burdens of decision making. There’s also evidence that family members inaccurately predict the healthcare desires of their loved one as much as a third of the time.
Preparing a living will
Help your parent prepare a living will with the following steps.
Ask your parent what matters most
Some people want to stay alive as long as possible while others may not wish to prolong uncomfortable symptoms.
Encourage your parent to talk with their doctor
Medicare covers talking with a doctor about advance care planning. Talking with healthcare providers can help your parent learn about their health issues and the kinds of decisions that may arise in the future.
Help your parent complete the living will form
You or your parent can find, download, and print free advance directive forms for their state. These may need to be witnessed or notarized, so read the directions closely. To minimize any confusion in the future, encourage your parent to be as specific as possible about which life-prolonging interventions they do and do not want.
Make sure your parent regularly updates the form
This is important to do once a year and after major life events, as someone’s preferences and wishes can change over time. An 80-year-old person who golfs several times a week may want more aggressive intervention than when they’re 90 and frail.
Once the forms are completed, they should be stored in a safe place. Copies should be given to the healthcare proxy and all care providers. Knowing that everyone is on the same page should give you and your parent peace of mind.
Why the right Medicare plan for your parent matters
While you’re helping your parent get their living will in order, it’s a good time to make sure they’ve got the Medicare coverage that’s right for them. Would they benefit from a Medicare Supplement policy that covers out-of-pocket costs, like co-pays? Could they use coverage for dental and vision? Are all their doctors and medications covered under their current policy? Check out plans available in their area with our easy-to-use Find a Plan tool.
- ClearMatch Medicare: Find a Medicare Plan
- NPR: Many Avoid End-of-Life Care Planning, Study Finds
- NBC News: Pulling the Plug: ICU ‘Culture’ Key to Life or Death Decision
- Everplans: State-by-State Advance Directive Forms
- University of Michigan: National Poll on Healthy Aging